Improper Salinas Valley prison admissions found

Patients were accepted into Salinas Valley State Prison's beleaguered psychiatric unit under risky conditions that violated the facility's own policies, The Herald has found.

Psychiatric staff members say the improper admissions occurred in February and March while the unit was pressured to reduce patient waiting lists. It also came as state officials anticipated a ruling on federal oversight of prison mental health.

The Department of State Hospitals has denied the allegations, saying the patients were all processed properly and that false information on patient intake forms was the result of computer glitches.

However, the department recently removed its top administrators from the troubled program, including executive director Charles DaSilva, who in late March told a federal court there were no staffing concerns at the facility even though the number of psychiatrists at the unit was well below state standards.

The improper patient admissions occurred after a senior psychiatrist at the prison stepped down during a wave of protests from fellow psychiatrists about severe staff shortages.

Documents obtained by The Herald show that in February and March, psychologists — not psychiatrists — accepted patients for transfer into the mental health program once touted as state of the art for treating severely mentally ill violent offenders.

The forms show that at least 10 patients were accepted on Feb. 25, March 4 and March 11 by Dr. Troy Newton, a psychologist from Seaside.

A number of the forms describe Newton as a psychiatrist, although state license records show he is not.

Another form shows a patient accepted by psychologist Dr. Brad Barcklay on Feb. 22.

According to the unit's manual as well as long-standing policy at the Salinas Valley facility, a psychiatrist must "determine mental health suitability" as part of the pre-admission screening process before a patient is accepted for transfer to the unit.

That's because psychiatrists are trained and licensed as physicians to evaluate whether a patient has prescription needs or additional health issues that are treatable at the facility.

But staff members say such pre-screenings by psychiatrists were bypassed in late February and early March.

Non-physicians are "not qualified or licensed to determine whether a symptom is caused by mental illness or a non-psychological medical illness," said Dan Willick, general counsel for the California Psychiatric Association.

"There is the danger that life-threatening medical problems not due to the mental illness will be ignored," Willick said.

That appears to have been the case for at least one man at Salinas Valley.

A patient was accepted by Newton for the program even though he suffered from cirrhosis and two types of cancer, and had to wear a diaper, records show.

Once in the program, the man had to be taken to two local hospitals for emergency treatment. He was ultimately discharged from the prison hospital because it wasn't equipped to care for his life-threatening ailments.

State hospital officials insist the actual admissions were conducted by psychiatrists, and that it is perfectly legal for psychologists to do the initial "accepting."

Department of State Hospitals spokesman Ralph Montano stressed that Newton did not perform any admissions.

"As a psychologist, Dr. Newton only accepted patients," Montano said in an emailed statement. According to the department, "accepting" means approving a potential patient's transfer to the facility. "Admitting" means he officially becomes a patient at the unit.

But even simply "accepting" patients, staff members say, was serious breach of policy.

Accepting patients without a psychiatrist's input was "outside the program's standards and practices," said Dr. Joel Badeaux, a psychiatrist who worked at the unit.

"To my knowledge, at that time none of us (psychiatrists) were in the loop as far as the decision whether to accept referrals for admission," he said.

Badeaux left the program in late March after he and eight fellow doctors complained to DaSilva that ongoing shortages of psychiatrists endangered inmates and staff.

Asked why Newton's title was listed first as "psychologist" but later as "psychiatrist" on patient acceptance forms, state hospital spokesman Montano said Newton signed a Department of Corrections and Rehabilitation-generated form "that did not reflect his correct title, which is psychologist."

He said the department has since corrected the error.

The department also provided The Herald with a spreadsheet purporting to show that February and March admissions were performed by two specific psychiatrists, even though the officials later acknowledged that those doctors no longer worked in that capacity at the time of the admissions.

One had actually left his job months earlier, and the other had just stepped down as senior psychiatrist.

Montano said the erroneous records were generated before the department updated its computer software to reflect personnel changes.

The acceptance policy breaches occurred just as a federal three-judge panel overseeing California's prison mental health care turned its attention to the facility.

The court's intense focus on the Salinas Valley Psychiatric Programs, know as SVPP, came after nine psychiatrists at the program signed letters to DaSilva in January and February, saying they were working under protest because severe low staffing levels made conditions dangerous for both staff and patients.

Then in March, patient Desmond Watkins, 36, died from severe overhydration complicated by a psychiatric condition in which patients experience dangerous cravings for water, according to a Monterey County coroner's report.

Several weeks later, the federal judges ruled that their decades of overseeing California's prison mental health would continue, despite protests from state lawyers that included a sworn declaration from DaSilva saying the care provided was more than adequate.

"There is presently no shortage of clinical staff at SVPP," DaSilva stated, though at the time the psychiatrist-to-patient ratio was half of recommended state standards.

One Salinas Valley psychiatrist said in a March court deposition that supervisors were pressuring staff to admit and release patients quickly, apparently in anticipation of the upcoming federal ruling.

"There was a general feeling — and I felt this way — that we were under pressure from administration to move the old people out, the old patients out, and take in new patients so as to keep our waiting list down," said Dr. John Brim.

Now, in the wake of DaSilva and others' departures, a new interim leadership team has been installed, although on Friday, after little more than two weeks on the job, interim executive director Dr. Robert Withrow stepped down.

Staff members say they're hopeful the new team means real change is coming to the unit, which in addition to the staffing troubles has been plagued by shortages of soap and clean sheets and underwear.

State hospitals' chief deputy director Kathy Gaither said, "We remain committed to providing the treatment and environment necessary to produce positive changes for our patients, and we are confident the new team is well-equipped to address the ongoing challenges at Salinas Valley."